Barrett’s
Esophagus
National Digestive Diseases Information Clearinghouse
What is Barrett’s esophagus?
U.S. Department
of Health and
Human Services
NATIONAL
INSTITUTES
OF HEALTH
Barrett’s esophagus is a condition in which
the tissue lining the esophagus—the mus
cular tube that connects the mouth to the
stomach—is replaced by tissue that is simi
lar to the lining of the intestine. This pro
cess is called intestinal metaplasia.
No signs or symptoms are associated with
Barrett’s esophagus, but it is commonly
found in people with gastroesophageal
reflux disease (GERD). A small number of
people with Barrett’s esophagus develop a
rare but often deadly type of cancer of the
esophagus.
Barrett’s esophagus affects about 1 percent1
of adults in the United States. The aver
age age at diagnosis is 50, but determining
when the problem started is usually difficult.
Men develop Barrett’s esophagus twice as
often as women, and Caucasian men are
affected more frequently than men of other
races. Barrett’s esophagus is uncommon in
children.
The Esophagus
The esophagus carries food and liquids
from the mouth to the stomach. The stom
ach slowly pumps the food and liquids into
the intestine, which then absorbs needed
nutrients. This process is automatic and
people are usually not aware of it. People
1
Cameron AJ. Epidemiology of Barrett’s esophagus
and adenocarcinoma. Diseases of the Esophagus.
2002;15:106–108.
Digestive tract.
sometimes feel their esophagus when they
swallow something too large, try to eat too
quickly, or drink very hot or cold liquids.
The muscular layers of the esophagus are
normally pinched together at both the
upper and lower ends by muscles called
sphincters. When a person swallows, the
sphincters relax to allow food or drink to
pass from the mouth into the stomach. The
muscles then close rapidly to prevent the
food or drink from leaking out of the stom
ach back into the esophagus and mouth.
What is gastroesophageal
reflux disease (GERD)?
GERD is a more serious form of gastro
esophageal reflux (GER). GER occurs
when the lower esophageal sphincter opens
spontaneously for varying periods of time
or does not close properly and stomach
contents rise into the esophagus. GER is
also called acid reflux or acid regurgitation
because digestive juices called acids rise
with the food or fluid.
When GER occurs, food or fluid can be
tasted in the back of the mouth. When
refluxed stomach acid touches the lining of
the esophagus it may cause a burning sensa
tion in the chest or throat called heartburn
or acid indigestion. Occasional GER is
common and does not necessarily mean one
has GERD.
Persistent reflux that occurs more than
twice a week is considered GERD and can
eventually lead to more serious health prob
lems. Overall, 10 to 20 percent2 of Ameri
cans experience GERD symptoms every
day, making it one of the most common
medical conditions. People of all ages can
have GERD.
GERD symptoms are often relieved by
over-the-counter, acid-reducing agents
called antacids. Common antacids include
• Alka-Seltzer
• Maalox
• Mylanta
• Pepto-Bismol
• Riopan
• Rolaids
2
El-Serag HB. Time trends of gastroesophageal reflux
disease: a systematic review. Clinical Gastroenterology
and Hepatology. 2007;5(1):17–26.
2 Barrett’s Esophagus
Other drugs used to relieve GERD
symptoms are anti-secretory drugs such as
H2 blockers and proton pump inhibitors.
Common H2 blockers are
• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)
• ranitidine (Zantac 75)
Common proton pump inhibitors are
• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)
• pantoprazole (Protonix)
• rabeprazole (Aciphex)
People who have GERD symptoms should
consult with a physician. If GERD is left
untreated over a long period of time, it
can lead to complications such as a bleed
ing ulcer. Scars from tissue damage can
lead to strictures—narrowed areas of the
esophagus—that make swallowing difficult.
GERD may also cause hoarseness, chronic
cough, and conditions such as asthma.
GERD and Barrett’s Esophagus
The exact causes of Barrett’s esophagus are
not known, but GERD is a risk factor for
the condition. Although people who do not
have GERD can have Barrett’s esophagus,
the condition is found about three to five
times more often in people who also have
GERD.
Since Barrett’s esophagus is more com
monly seen in people with GERD, most
physicians recommend treating GERD
symptoms with acid-reducing drugs.
Improvement in GERD symptoms may
lower the risk of developing Barrett’s esoph
agus. A surgical procedure may be recom
mended if medications are not effective in
treating GERD.
How is Barrett’s esophagus
diagnosed?
Because Barrett’s esophagus does not cause
any symptoms, many physicians recom
mend that adults older than 40 who have
had GERD for a number of years undergo
an endoscopy and biopsies to check for the
condition.
Barrett’s esophagus can only be diagnosed
using an upper gastrointestinal (GI) endos
copy to obtain biopsies of the esophagus. In
an upper GI endoscopy, after the patient is
sedated, the doctor inserts a flexible tube
called an endoscope, which has a light and
a miniature camera, into the esophagus.
If the tissue appears suspicious, the doc
tor removes several small pieces using a
pincher-like device that is passed through
the endoscope. A pathologist examines the
tissue with a microscope to determine the
diagnosis.
What is the risk of
esophageal cancer with
Barrett’s esophagus?
People with Barrett’s esophagus have a low
risk of developing a kind of cancer called
esophageal adenocarcinoma. Less than
1 percent3 of people with Barrett’s esopha
gus develop esophageal adenocarcinoma
each year. Barrett’s esophagus may be pres
ent for several years before cancer develops.
Esophageal adenocarcinoma is frequently
not detected until its later stages when
treatments are not always effective.
Surveillance for Dysplasia
and Cancer
Periodic endoscopic examinations with
biopsies to look for early warning signs
of cancer are generally recommended for
people who have Barrett’s esophagus. This
approach is called surveillance.
Normal esophagus.
Barrett’s esophagus.
3 Barrett’s Esophagus
Typically, before esophageal cancer devel
ops, precancerous cells appear in the
Barrett’s tissue. This condition is called
dysplasia and can be seen only through
biopsies. Multiple biopsies must be taken
because dysplasia can be missed in a single
biopsy. Detecting and treating dysplasia
may prevent cancer from developing.
3
Shaheen N, Ransohoff DF. Gastroesophageal
reflux, Barrett’s esophagus, and esophageal cancer.
Journal of the American Medical Association.
2002;287(15):1982–1986.
How is Barrett’s esophagus
with dysplasia or cancer
treated?
Endoscopic or surgical treatments can
be used to treat Barrett’s esophagus with
severe dysplasia or cancer. Your doctor
will present the available options and help
determine the best course of treatment for
you.
Endoscopic Treatments
Several endoscopic therapies are available
to treat severe dysplasia and cancer. Dur
ing these therapies, the Barrett’s lining is
destroyed or the portion of the lining that
has dysplasia or cancer is cut out. The goal
of the treatment is to encourage normal
esophageal tissue to replace the destroyed
Barrett’s lining. Endoscopic therapies are
performed at specialty centers by physicians
with expertise in these procedures.
• Photodynamic Therapy (PDT). PDT
uses a light-sensitizing agent called
Photofrin and a laser to kill precancer
ous and cancerous cells. Photofrin is
injected into a vein and the patient
returns 48 hours later. The laser light
is then passed through the endoscope
and activates the Photofrin to destroy
Barrett’s tissue in the esophagus.
Complications of PDT include chest
pain, nausea, sun sensitivity for several
weeks, and esophageal strictures.
4 Barrett’s Esophagus
• Endoscopic Mucosal Resection
(EMR). EMR involves lifting the
Barrett’s lining and injecting a solution
under it or applying suction to it and
then cutting it off. The lining is then
removed through the endoscope. If
EMR is used to treat cancer, an endo
scopic ultrasound is done first to make
sure the cancer involves only the top
layer of esophageal cells. The ultra
sound uses sound waves that bounce
off the walls of the esophagus to create
a picture on a monitor. Complications
of EMR can include bleeding or tear
ing of the esophagus. EMR is some
times used in combination with PDT.
Surgery
Surgical removal of most of the esophagus
is recommended if a person with Barrett’s
esophagus is found to have severe dyspla
sia or cancer and can tolerate a surgical
procedure. Many people with Barrett’s
esophagus are older and have other medical
problems that make surgery unwise; in these
people, the less-invasive endoscopic treat
ments would be considered. Surgery soon
after diagnosis of severe dysplasia or cancer
may provide a person with the best chance
for a cure. The type of surgery varies, but
it usually involves removing most of the
esophagus, pulling a portion of the stomach
up into the chest, and attaching it to what
remains of the esophagus.
Points to Remember
• In Barrett’s esophagus, the tissue
lining the esophagus is replaced by
tissue that is similar to the lining of
the intestine.
• Barrett’s esophagus is associated
with gastroesophageal reflux
disease (GERD).
• Improvement in GERD symptoms
with acid-reducing drugs may
decrease the risk of developing
Barrett’s esophagus.
• Barrett’s esophagus is diagnosed
through an upper gastrointestinal
endoscopy and biopsies.
• People who have Barrett’s esopha
gus should have periodic surveil
lance endoscopies and biopsies.
• Endoscopic treatments are used to
destroy Barrett’s tissue, which will
hopefully be replaced with normal
esophageal tissue.
• Removal of most of the esophagus
is recommended if a person with
Barrett’s esophagus is found to
have severe dysplasia or cancer and
can tolerate a surgical procedure.
5 Barrett’s Esophagus
Hope through Research
The National Institute for Diabetes and
Digestive and Kidney Diseases and the
National Cancer Institute sponsor research
programs to investigate Barrett’s esopha
gus and esophageal adenocarcinoma.
Further research into Barrett’s esophagus
is needed, including
• establishing additional tests to identify
people with Barrett’s esophagus
• identifying the cause(s) of Barrett’s
esophagus
• studying the long-term effectiveness
of treatments such as PDT and EMR
• developing additional nonsurgical
treatments for people who have
Barrett’s esophagus and dysplasia or
cancer
Participants in clinical trials can play a
more active role in their own health care,
gain access to new research treatments
before they are widely available, and help
others by contributing to medical research.
For information about current studies, visit
www.ClinicalTrials.gov.
The U.S. Government does not endorse or favor any
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proprietary, or company names appearing in this
document are used only because they are considered
necessary in the context of the information provided.
If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.
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Fax:414–964–7176
Email:[email protected]
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U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIHPublicationNo.08–4546
July2008